Provider Demographics
NPI:1649714155
Name:ABOUT CARE GYN ASSOCIATES, PLLC
Entity type:Organization
Organization Name:ABOUT CARE GYN ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN , SOLE MEMBER OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOSIMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-859-5225
Mailing Address - Street 1:PO BOX 220925
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20153-0925
Mailing Address - Country:US
Mailing Address - Phone:703-859-5225
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 309
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-859-5225
Practice Address - Fax:844-898-2182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-19
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053044261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6201547Medicaid
VAG60878Medicare UPIN
VA003004Medicare PIN